What's A POLST (Physicians Orders for Life Sustaining Treatment)?

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A POLST form is a legal document for people with an advanced progressive or terminal illnesses and specifies the type of care a person would like in an emergency medical situation.

POLST Overview

A POLST (Physicians Orders for Life Sustaining Treatment) is basically a more detailed and specific DNR (Do Not Resuscitate Orders). Like a DNR, this form is filled out with your doctor and based on your end-of-life care decisions. Once signed, doctors, emergency medical professionals, and other health care professionals must honor the instructions on your POLST form, no matter where you are (at a hospital, care facility, your own home, etc.). In an emergency situation, any procedures that are legally required of emergency personnel will be overridden by your personal decisions indicated on your POLST.

Depending on what state you live in, a POLST may go by one of the following names:

MOST (Medical Orders for Scope of Treatment)

MOLST (Medical Orders for Life Sustaining Treatment)

POST (Physician Orders for Scope of Treatment)

TPOPP (Transportable Physician Orders for Patient Preferences)

The forms differ in name and structure depending on where you live, but are conceptually the same across all states.

Helpful Tip: POLST forms are often printed on brightly colored paper so that they’re easy to see and find.

What's Included In A POLST?

Depending on your state, the POLST form contains 3 or 4 sections, each addressing a different aspect of end-of-life medical care. The POLST lets you choose which level of treatment you would like to receive in a medical emergency in respect to:

Cardiopulmonary resuscitation (CPR): If you have no pulse and are not breathing, you can choose to have emergency medical professionals attempt resuscitation or not attempt resuscitation.

Comfort measures only, such as medication, with instructions that you should not be transferred to a hospital.

Limited additional interventions, such as medical treatment, IV fluids and cardiac monitor, with instructions that you may be transferred to a hospital if needed, but should avoid intensive care if possible.

Full treatment, such as intubation or advanced airway interventions, mechanical ventilation (breathing machine), and cardioversion (to re-set the heart’s rhythm), with instructions that you should be transferred to a hospital if needed, and may be transferred to intensive care.

Antibiotics: You can choose to receive no antibiotics, limited use of antibiotics with comfort as the goal, or full use of antibiotics.

Artificially administered hydration/nutrition: You can choose to receive no hydration and artificial nutrition by tube, a trial period of hydration and artificial nutrition by tube, or long-term artificial hydration and nutrition by tube.

How A POLST Form Is Different From A Living Will

There are many similarities between POLST forms and Advance Directives or Living Wills—specifically, all these types of documents indicate the type of care and treatment you’d like at the end of your life. However, there are three key differences that make POLST forms uniquely effective in end-of-life planning.

1. POLST forms are medical orders. A POLST form is signed by your physician, and is therefore a medical order (a Living Will is not). A Living Will can inform medical professionals about the type of care you’d like, only a POLST can instruct medical professionals about the care and treatments you’d like. Any emergency medical personnel (such as EMTs) and non-emergency medical professionals (such as nurses) are legally obligated to follow the instructions of the POLST; they are not required to follow the instructions of a Living Will.

2. POLST forms address current, specific medical situations. A Living Will can be filled out at any time in your life, and addresses how you would generally like to be cared for at the end of your life. POLST forms, on the other hand, are only filled out when you’ve reached an advanced illness, and therefore speak to how you would like to be cared for given your current condition and situation.

3. POLST forms are “portable.” The POLST form moves with you between facilities, hospitals, etc... as a part of your medical record, and must be honored by the health care professionals in any location. Whatever type of medical facility you are in, including treatment in your own home, the decisions spelled out in your POLST will be honored.

If You Don’t Have A POLST Form

By law, EMTs and other emergency medical professionals are required to carry out certain life-sustaining treatments, such as cardiopulmonary resuscitation (CPR) if someone’s heart or breathing stops. If you don't want to receive these treatments, you need to have either a POLST or a DNR stating so. (Both a POLST and a DNR are medical orders that EMTs and other emergency medical professionals must honor.)

Who Can Complete A POLST Form?

In every state where POLST forms exist, patients with advanced illnesses may complete one with their doctor. (In some cases, patients may have to consult with their doctors to determine if they are at an appropriate stage of life for a POLST form.) In some states, a family member or Health Care Proxy may be able to complete a POLST form on behalf of the patient. You can always check with your doctor to learn more about your state’s provisions.

How Do POLST Forms Differ Across States?

Every state that has a POLST form generally covers the same information in their form. As mentioned above, while the name of the form may differ, they are conceptually the same across all states. Though some states may have reciprocity with other states, meaning that the POLST form you fill out in one state may be usable in other states, it’s a safe idea to fill out forms from each state that's relevant to you.

How To Get And Fill Out A POLST Form

Depending on where you live, you can either download the POLST form yourself and fill it out in conjunction with your doctor, or you may need to get the form directly from your doctor. POLST forms can also be completed with nurse practitioners, physicians assistants, social workers, and other medical professionals. The form must be signed by both the patient and the physician or medical professional. If a medical professional has not co-signed the form, it's not legally binding.

Storing Your POLST Form

The original POLST form always remains with the patient regardless of whether he or she lives at home, is the in hospital, is at a nursing home, or at another location. If you’re in a home setting, the POLST form should be stored somewhere that emergency medical personnel will easily see it, such as on your refrigerator, by your bed, or by your front door. If they do not see the POLST form or cannot find the form, they will go about their normal procedures. If you’re in a medical setting, the doctor managing your care must have the original copy of the POLST attached to your medical file or chart.

Once you have filled out the form, make sure that your Health Care Proxy and your doctor both have a copy. Inform your family that the form has been filled out. Be sure to let them know where it's stored so that they can show it to emergency personnel in the event that they are present during an emergency.